Archive for December, 2014

This morning I read a blog post by Carolyn Hall entitled “6 Things I Don’t Understand About the Fat Acceptance Movement.” I realize that as with so many contentious current issues, people on all sides are so entrenched in their own views they struggle to step back and look at the whole picture. We all do this – we judge what we see and hear based upon our own life experiences. The bigger problem occurs when we are not open to changing our preconceived notions. As I tell my university students – if we want to be part of the solution to our current problems we must learn to communicate with people who don’t think like we do. This post is an attempt to do just that.

Though I felt frustrated reading this article I recognize Hall’s questions are shared by many who are unfamiliar with the nuances of the HAES (Health at Every Size) approach and provide an opportunity to respond with my take on these questions. I assume this author genuinely wants to hear a different view point and respond to her 6 points accordingly. Each response is based on my 14 years of work as a Registered Dietitian with a major focus on a non-diet approach to health, and a specialty working with problem eating all along the continuum, including eating disorders.

1. America is extremely accepting of fat.

Only someone who has not lived in America in a fat body could make this statement. To be clear, despite feeling fat most of my life starting in preadolescence, and going through periods of being 20-25 pounds or so above what is considered “healthy” for my height, my work with clients in larger bodies has shown me that I do not really know what it is like to be fat in our culture. I am haunted by their life stories however, and I can assure you this statement is not accurate.

I do agree with Hall that our culture accepts and even encourages many of the factors that contribute to unhealthy lifestyles, including excess weight and inadequate physical movement. As a whole (with some very vocal exceptions) we accept a food system that produces and promotes a plethora of unhealthy foods and makes them cheap, convenient, and accessible 24/7 for most of us. We accept that our “busy lives” don’t include time to prepare and eat health-promoting food at regular intervals and without distractions. We don’t encourage people to connect with their internal cues of hunger and fullness or with how their physical and mental health is linked to their eating habits. We accept a fear-based approach to education about virtually everything, including nutrition, and then blame people who don’t make sustainable changes based on fear (a topic for another post).

2. “Body positivity” should include health.

I cannot speak for every member of the Fat Acceptance or Health At Every Size Movements but I can tell you as a longtime advocate of a non-diet approach to health, and an eating disorder professional, my motivation to do this work is a focus on health. As with all social “movements” I suspect there are advocates with extreme and more rigid views than mine but having read many books by HAES proponents, any suggestion that health is not a key part of this movement is a misinterpretation.

The problem I see is that weight and health are so intertwined we overlook the fact that many lifestyle changes related to food, exercise, stress resilience, and more, can improve health with little or no change in body weight. Even if weight loss can increase health benefits, which is likely to be true in the extreme cases of morbid obesity the author refers to throughout her article, as long as positive lifestyle changes are tethered to weight loss, we encourage yo-yo dieting and unsustainable changes linked to metabolic mayhem that are not likely to yield long-term health benefits.

Body positivity does not mean you love being fat or want everyone to be fat. Accepting that you are a human being with worth that extends beyond your appearance is body positivity. In my experience working with people who struggle with food, weight and body image, the preoccupation with body weight, shape and size occurs in underweight, overweight and healthy weight individuals, male, female and transgendered. Shifting the focus toward what Connie Sobczak calls “intuitive living” in her excellent book Embody, is about self-care in every aspect of our lives. As long as we are only focused on a number on the scale we are not truly engaged in sustainable self-care.

3. “Health at every size” seems physically impossible.

Again, Hall is hung up here on the extremes – as many critics of the HAES approach are. As stated above, the main idea is that we need to shift the focus from weight to health, for everyone. Weight gain, or loss, may be part of the bigger health picture for people at the extremes of anorexia and morbid obesity. However, I see clients on a regular basis who are within a “healthy” weight range and routinely engage in unhealthy behaviors in an attempt to change (or maintain) the way they look.

I cannot count the number of times clients report compliments about how “good” they look or how much weight they’ve lost after days of erratic eating, purging, starving themselves, or exercising in dangerous ways. They not only hear this positive feedback from friends and co-workers but health professionals – doctors, personal trainers, and yes, sadly, nutritionists. All of us can be blind to the physical and emotional health consequences of a weight-focused vs. health-focused culture.

4. People are allowed to not be attracted to certain body types.

I have no issue with this statement. Attraction is thankfully diverse and individualized. My issue is that the fat shaming prevalent in our culture is an accepted form of discrimination and prejudice. Though I don’t believe we are anywhere near “post-racial” or beyond any other form of discrimination widely accepted earlier in my lifetime, I see examples on a regular basis of serious discrimination based on weight that is totally accepted in mainstream culture. Even people who still believe race, ethnic background, sex, gender, or religious preferences are undesirable, don’t express such views widely (except of course on the internet). Yet somehow there is a general acceptance of negative comments made about someone’s weight. As a society we allow fat to be a code word for lazy, stupid, weak, and other harmful judgments.

Promoting the idea that people come in different shapes and sizes does not mean we all suddenly have to be attracted to fat people. This is more of a social justice issue than a personal attraction or general health issue.

5. Food addiction is a real medical problem.

A complete response to this point is easily an entire blog post unto itself. In brief however, the concept of “food addiction” is controversial, particularly if we attempt to address this “diagnosis” as we do addictions to other substances. There are many issues that contribute to both what and how much we eat on a regular basis. While biochemistry and neuroscience can explain pieces of this complex puzzle, any attempt to reduce problem eating to “simple addiction” is not helpful.

Foods that are highly processed and bypass our internal cues of hunger and fullness are a problem. As stated previously these foods are cheap, convenient, and accessible. They are also heavily promoted using results from billions of dollars of food psychology research. I fully agree we need to address these issues.

To understand eating problems more completely however, we need to include the biochemical aspects of our response to food, along with our long-established neural pathways or habits, various influences in our food environments, and other aspects of human behavior. Evolutionary psychology can also help us better understand our currently maladaptive tendencies with the curiosity and compassion we need to make significant and sustainable changes to our behavior.

Like it or not, eating habits are complicated and reductionist “solutions” must be recognized as such. The HAES movement may not focus on all of the points I mention here but it does recognize the “answers” to the “obesity crisis” are not simple.

6. Childhood obesity is something we can’t be accepting of.

I could not agree more on this point. I know many health professionals who endorse non-diet and HAES approaches and none of them are “pro-obesity” of any sort, especially among children. Raising children to eat based on fear – don’t eat this or that because you will get sick, or worse, get fat, is not helpful. Continuing to advocate a weight-focused vs. overall health-focused paradigm will not help our children. They need to know that eating nutritious foods and moving their bodies daily is good for their brains, bodies, mood, energy levels, and overall health. But they also deserve to know that thin does not equal healthy; that as they transition from childhood to adolescence and then into adulthood, their bodies will grow and change, and these changes don’t mean they are unacceptable when they don’t fit narrowly defined ideals of beauty.

Our children need to know there is no “perfect body” or “perfect diet.” In fact it would be great if they abandoned the notion of perfection altogether. Striving to do the best they can is awesome. Chasing the illusion of perfection can be dangerous.

It is our responsibility as adults to provide an environment for our children that supports good health and a sense of well-being. In our current culture this is no easy feat. It is clear however, that what we have been doing for the past few decades is not working. Focusing on short-term fad diets, succumbing to the trappings of modern society that support unhealthy lifestyles and then blaming people who gain weight or don’t exercise enough, using fear-based tactics in an attempt to change people’s habits, are not helpful strategies to produce the changes we want to see.

I don’t like the phrase “fat acceptance.” I prefer “human acceptance” which gets more to the core of our various health problems linked to weight. In fact we know that the statistics related to weight and health also apply to socioeconomic status and health. This doesn’t mean we don’t pay attention to these relationships but hopefully it means we try harder to understand the complexity of the issues beyond what we see on the scale.

There is no single way out of the mess we are in related to poor health as a society. Blame, shame, fear, anger, and a lack of compassion for ourselves and others are not working to make us healthier physically or mentally. What I am drawn to in alternate paradigms such as Health at Every Size (HAES) is the refusal to reduce our current health problems to weight alone, nor to continue clinging to approaches that don’t work. It is time for a fresh perspective and frankly I don’t care what we call it as long as it takes us in a more positive direction.

What I’m going to share with you today applies to any behavior change. I’m going to use a food example that most of us can relate to as eaters entering the holiday season.

Imagine this scenario:

You decide this year that you are going to take it easy on sweet treats throughout the holidays. Not only do you feel better on a daily basis when you keep sweets in balance, but this change is consistent with your long-term health goals.

You go to work and shortly after you arrive a co-worker walks in with a plate of home-baked cookies – your favorite kind. And there are a lot of them. You graciously accept a cookie then immediately start criticizing yourself for eating it. That voice inside starts in: “Not even an hour into the workday and you’ve eaten a cookie, so much for that healthy eating goal.”

Then you have a second cookie. The voice gets louder, and harsher. By the time lunch rolls around you’ve lost count of how many cookies you ate. You go out to lunch and order dessert after your cheeseburger and fries because at this point you have “blown” your healthful eating plan for the day.

You have just experienced a well-known behavioral psychology phenomenon called the “What-the-Hell Effect.” This cycle of indulgence-regret-greater indulgence was first described by psychology researchers Polivy and Herman.

Now I want you to think about what happens in these “What-the-Hell” situations for you. What are some of the things you tell yourself?

The most common response I hear from my clients is “I have no willpower.” They believe they “cave in” to temptation because somehow they just don’t have enough willpower or their love of food is so powerful they cannot resist that first cookie. They are convinced that first cookie paves the way to “What-the-Hell.”

The reality is that the initial decision to revert back to an old habit, to eat that first cookie, is NOT what leads to the What-the-Hell behavior. It is our feelings of guilt, shame, loss of control, or loss of hope that follow the first relapse that lead us to continue the path away from our longer-term goals.

According to Kelly McGonigal, a psychology researcher at Stanford who studies Willpower, to break this “What-the-Hell” cycle of indulgence-regret-greater indulgence we need self-forgiveness. We may think guilt motivates us to correct our mistakes but it’s just one more way that feeling bad leads us to give in.

Now here is where things get really interesting. There is another important factor in this scenario: your brain.

Some of you may be familiar with neurobiologist Dan Siegel’s “Hand Model of the Brain” (if not click here). The limbic area of the brain is where our “fight/flight” response starts when we are faced with a potential physical or emotional threat. Dr. Siegel calls this the “lower brain”.

The cortex, including the prefrontal cortex or the “upper brain,” covers the limbic area, and enables us to reason and to see the bigger picture –specifically our longer-term goals. Decisions from our lower brain are impulsive, short-sighted and reactive.

When we berate ourselves for eating the cookies, we engage the stress-response in our lower brain and set ourselves up to continue not acting in accordance with our longer-term goals. Blood actually diverts away from the cortex or upper brain.

When we beat ourselves up mentally, our brain works against us!

Study after study of adults shows that self-criticism is consistently associated with less motivation and worse self-control.

Self-compassion – being supportive and kind to yourself, especially in the face of stress and failure, is associated withmore motivation and better self-control.

Self- kindness (treat ourselves as we would a loved one who is struggling)

Recognize our shared humanity (we are all imperfect –connects us)

Mindfulness of our inner critic and our discomfort (to respond differently we first must be aware of what is happening)

Going back to our example of the cookie, what if your initial response is “wow, that cookie is delicious” and you eat it slowly, savoring the taste, appreciating that your co-worker made this cookie from scratch?

Afterwards when you are tempted to have another cookie (or 5), you take a few deep breaths instead. You gently remind yourself that enjoying a cookie here and there is consistent with your longer term health goals, but wolfing down 4 more cookies right now probably isn’t. You don’t beat yourself up for eating that first cookie. You are human and many humans like cookies!

When your inner critic kicks in and starts screaming: “You idiot! Why did you eat that cookie? What were you thinking?” you calmly respond, “I wanted the cookie and it was delicious.” End of story. If you stay calm, blood continues to flow to all parts of your brain and you are able to remember your longer-term goals.

This self-compassionate and calm response takes away the driver of the “What-the-Hell” (WTH) effect– if there is no guilt and self-criticism, then there is nothing to escape.

As we enter the holiday season filled with all kinds of ways to tempt us away from our health-promoting self-care habits, a time when we are prone to the “What-the-Hell” effect and to impulsive decisions made by our “lower brain” due to stress, let’s think about sharing some of the compassion we give freely to others, with ourselves as well.

In addition to the many holiday stresses, alcohol, sleep deprivation and distraction can also trigger our “lower brain” and cause us to abandon our longer-term goals. In these situations we need to be extra kind to ourselves. We also need a strategy to help calm our stress response and promote resilience.

One of the simplest stress relievers is to take 3 deep belly breaths. LET’S TRY THIS – 3 deep belly breaths, each followed by a long, slow exhale. ONE, TWO, THREE.

If you were stressed and your limbic brain was threatening to take charge, those 3 deep breaths just redirected the blood flow to your whole brain. Now your cortex has a chance to be part of your decision making.

This calmness in combination with self-kindness may be your most enjoyable holiday treats ever –ones you can look back on in January with a smile on your face!